When a "Normal" Eye Exam Doesn't Tell the Whole Story

For many parents, the frustration is the same: They sense something is wrong with their child’s vision, yet the results from every eye exam come back normal. According to Christine Roman-Lantzy, Ph.D., founder and director of Pediatric VIEW at The Children’s Home of Pittsburgh, that disconnect is not a coincidence. It is often a red flag for cortical visual impairment, or CVI, a brain-based visual condition that a standard eye exam cannot detect.

Roman-Lantzy said CVI is identified through three diagnostic criteria: an eye exam that does not explain how a child uses vision functionally; a history of a neurologic difference such as a stroke, brain bleed, infection or genetic condition; and the presence of specific visual and behavioral characteristics associated with CVI. She encourages pediatricians to ask not just what an eye exam shows but how a child is actually using their vision day to day.

Roman-Lantzy developed the CVI Range, a clinical assessment tool, over decades of work in the field. A new peer-reviewed study conducted by the neuro-ophthalmology department at Children’s Hospital Los Angeles, published in Ophthalmology Science, adds a rigorous, four-year scientific validation to earlier findings first published in 2010. While the CVI Range is not a diagnostic tool on its own, Roman-Lantzy said a positive profile gives families objective evidence they can bring to pediatricians, eye doctors and neurologists to support further evaluation.

For families facing pushback or delays, Roman-Lantzy pointed to protections under the Individuals With Disabilities Education Act. A child whose vision affects educational performance qualifies for services such as a teacher of the visually impaired or an orientation and mobility specialist, regardless of whether a formal medical diagnosis has been made.

Early identification matters significantly, Roman-Lantzy said, because children who do not use their functional vision consistently may increasingly rely on other senses, making later intervention far more difficult. CVI is also frequently misidentified as autism, attention-deficit/hyperactivity disorder or anxiety disorder, she said, which can lead to interventions that do not address the underlying visual access issue.

Stacy Schesler, CEO of the Children’s Home of Pittsburgh, described the impact of CVI training across her organization’s programs. After screening children in the organization’s medically complex day care program, staff discovered that half had CVI. Schesler said the discovery reshaped how her entire team operates. “It has changed every single thing that all our programs do," she said, noting that therapists, teachers, nurses and provider teams are now trained to recognize CVI.

Roman-Lantzy said she sees growing collaboration across medicine, education and therapy as the most encouraging development in the field, pointing to the new study itself, a partnership between researchers and an educator, as an example of professionals breaking out of traditional silos to better serve children with CVI.